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Endoscopic cricoid split in a tertiary referral paediatric centre

Published online by Cambridge University Press:  16 July 2018

S Carr ,
A Dritsoula  and
R Thevasagayam
S Carr*
Affiliation:
Department of Otolaryngology, Sheffield Children's Hospital, UK
A Dritsoula
Affiliation:
Department of Otolaryngology, Sheffield Children's Hospital, UK
R Thevasagayam
Affiliation:
Department of Otolaryngology, Sheffield Children's Hospital, UK
*
Author for correspondence: Mr S Carr, Department of Otolaryngology, Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH, UK E-mail: [email protected]
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Abstract

Background

Anterior cricoid split is performed for grade 2 and 3 subglottic stenosis, which can be a cause of extubation failure. It can be performed endoscopically or as an open procedure. This paper describes a case series of endoscopic cricoid split procedures performed using a bespoke sickle knife.

Method

Nine patients (six pre-term infants) underwent endoscopic cricoid split in a tertiary referral paediatric unit between August 2012 and March 2015.

Results

Six patients (67 per cent; four pre-term and two term infants) were on oxygen pre-operatively. Mean age at operation was 30 weeks (range, 11–104 weeks). Mean number of days’ intubation was 5.6 days (range, 4–9 days). All five patients intubated pre-operatively were extubated. Seven patients required repeat dilatations. One patient required tracheostomy.

Conclusion

The extubation rates for endoscopic cricoid split are comparable to the open procedure. It is a safe and efficient method for managing subglottic stenosis, whether acquired or congenital. The main advantage is the shorter operative time, in addition to the avoidance of an external scar and drain.

Keywords

Acquired Subglottic StenosisCongenital Subglottic StenosisEndoscopySurgery
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 8 , August 2018 , pp. 753 - 756
Copyright
Copyright © JLO (1984) Limited, 2018 

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Footnotes

Mr S Carr takes responsibility for the integrity of the content of the paper

Presented as a poster at the British Academic Conference in Otolaryngology, 8–10 July 2015, Liverpool, and orally at the British Association of Paediatric Otolaryngology, 18 September 2015, Belfast, Northern Ireland, UK.

References

1Cotton, RT, Seid, AB. Management of the extubation problem in the premature child: anterior cricoid split as an alternative to tracheotomy. Ann Otol Rhinol Laryngol 1980;89:508–11Google Scholar
2Tweedie, DJ, Skilbeck, CJ, Cochrane, LA, Cooke, J, Wyatt, ME. Choosing a paediatric tracheostomy tube: an update on current practice. J Laryngol Otol 2008;122:161–9Google Scholar
3Pashley, NR. Anterior cricoidotomy for congenital and acquired subglottic stenosis in infants and children. J Otolaryngol 1984;13:187–90Google Scholar
4Seid, AB, Canty, TG. The anterior cricoid split procedure for the management of subglottic stenosis in infants and children. J Pediatr Surg 1985;20:388–90Google Scholar
5Holinger, LD, Stankiewicz, JA, Livingston, GL. Anterior cricoid split: the Chicago experience with an alternative to tracheostomy. Laryngoscope 1987;97:19–24Google Scholar
6Anderson, GJ, Tom, LW, Wetmore, RF, Handler, SD, Potsic, WP. The anterior cricoid split: the Children's Hospital of Philadelphia experience. Int J Pediatr Otorhinolaryngol 1988;16:31–8Google Scholar
7Rotenberg, BW, Berkowitz, RG. Changing trends in the success rate of anterior cricoid split. Ann Otol Rhinol Laryngol 2006;115:833–6Google Scholar
8Mirabile, L, Serio, P, Baggi, R, Couloigner, V. Endoscopic anterior cricoid split and balloon dilation in pediatric subglottic stenosis. Int J Pediatr Otorhinolaryngol 2010;74:1409–14Google Scholar
9Horn, DL, Maguire, RC, Simons, JP, Mehta, DK. Endoscopic anterior cricoid split with balloon dilation in infants with failed extubation. Laryngoscope 2012;122:216–19Google Scholar
10Silver, FM, Myer, CM 3rd, Cotton, RT. Anterior cricoid split. Update 1991. Am J Otolaryngol 1991;12:343–6Google Scholar
11Walker, P, Forte, V. Failed extubation in the neonatal intensive care unit. Ann Otol Rhinol Laryngol 1993;102:489–95Google Scholar
12Matute, JA, Villafruela, MA, Delgado, MD, Berchi, FJ, Vazquez, J. Surgery of subglottic stenosis in neonates and children. Eur J Pediatr Surg 2000;10:286–90Google Scholar
13Eze, NN, Wyatt, ME, Hartley, BE. The role of the anterior cricoid split in facilitating extubation in infants. Int J Pediatr Otorhinolaryngol 2005;69:843–6Google Scholar